Take a Bite Out of This: What Your Teeth Could Be Doing to the Rest of the Body

There may be no bigger hassle than a dental problem. A root canal, an implant, a denture, or a chipped tooth: it’s all a big pain and a big hit to your bank account. And unfortunately, as we age so do our teeth. Just like your ovaries, they have been present for all your bad decisions. The sweets, the “oops, I forget to brush and floss,” and the endless packs of gum have taken their toll. (Trust us, we know, we do it too!) And while it may come as a shock to you, what’s going on your mouth may be a barometer for what’s going on in the rest of your body.

Oral health disorders like periodontal disease (a medical way of saying “gum disease”) have been associated with problems like cardiovascular disease, diabetes, Alzheimer’s, respiratory infections, and even preterm labor. Inflammation in the gums can lead to inflammation in other parts of the body. Picture this—bacteria make their way into the body through the gums. The gums have lots of blood vessels. Blood vessels act like a shuttle transporting bacteria throughout the body. Wherever they land, they bring inflammation. Inflammation in the blood vessels can cause the blood vessels to narrow. Narrow blood vessels cause blood flow to slow down and clots to form. Such clots increase the risk for heart attack and stroke. Because women post-menopause are already at increased risk for heart disease due to age and other medical risk factors, you don’t want to add to it by introducing gum disease and inflammation.

But there is more to the teeth’s story than gum inflammation and bacteria. After menopause, estrogen levels drop. This drop not only causes hot flashes and vaginal dryness but also the loss of bone in the jaw. Bone loss can lead to loose teeth and tooth loss. And unfortunately, when you lose a tooth at 55, there is no tooth fairy—just a lot of dental bills and inconvenience!

On top of the age and decreased estrogen part, medications that are used for osteoporosis have been linked to osteonecrosis (a.k.a. bone decay). And while this is very rare and most often seen in women with cancer who are on high-dose bisphosphonates, it is important to give your dentist frequent updates on your medication list so that your dental work is scheduled appropriately.

To make matters a little more distasteful, menopause and its hormonal fluctuations can also bring oral discomfort. Post-menopausal women report changes in their taste perceptions and dry mouth. And your gums feel it, too. Receding gums and sensitive gums are not uncommon.

Age gets us all over. From your hair and skin to your bones and toes, time takes a toll. Your teeth didn’t want to be left out! To decrease damage, the American Dental Association recommends that you make a trip to see your dentist twice a year. And for your homework, they suggest daily brushing and flossing. Also, limiting sugary foods and things that stick is a sure-fire way to improve your dental health.

So, don’t follow the nearly 35% of US women who did not see a dentist last year. Make an appointment to get those pearly whites (or at this point, some shade of white) checked out. You will be doing your whole body good.

Fibroid: What to Do When Fertility Is Not on Your Mind

If you have fibroids, you are probably saying a choice curse word every time you think of your little (and in some cases) big uterine friend(s). Like a bad house guest, they can be a big pain in the rear end. They can cause bleeding, pain, pressure, and infertility. Bottom line, they are not fun. And unfortunately, this un-fun party is very well attended; nearly a quarter of reproductive-age women have fibroids. Furthermore, fibroids are the cause for about 2% of infertility cases.

Simply stated, you are not the only person who RSVPed “yes” to the fibroid gala. While there are many ways to treat them, not everything works for everyone at every point in their life. Women at different stages of their lives (a.k.a. reproductive “stages”) and symptomology warrant different procedures. For those of you who are nowhere near ready for anything to do with the F word (FERTILITY) but want it in the future (be it near or distant), here’s what we recommend.

Fibroids can be treated medically and/or surgically. Medical treatments include oral contraceptive pills (a.k.a. OCPs or the pill), the intra-uterine device (a.k.a. the IUD), Lupron (a.k.a. “I feel like I am in menopause with these hot flashes and vaginal dryness”), progesterone receptor modulators (mifepristone or ulipristal acetate), SERMs (raloxifene), aromatase inhibitors (letrozole), and anti-fibrinolytics. While some of the medical options are better at improving some of the symptoms (for example, OCPs will improve heavy bleeding but not the pressure symptoms), they very rarely fix it all.

Just like when you’re selecting the OCP you want to marry, you may have to shop around for medical options before you land at your symptom-free spot. While Lupron (a GnRH agonist) will do it all, it will cost you in the side effect department. Hot flashes, sleep problems, vaginal dryness, muscle and bone pains, and even changes in mood/thinking often come along with the reduction in fibroid bleeding, pain, and pressure. It’s because of the side effect profile that we don’t go with Lupron as our first medical treatment.  

Surgically, the options are limited for women who have not yet had kids. It’s basically a myomectomy or bust. Fibroids have been nicknamed myomas; -ectomy means removal so myomectomy = fibroid removal. While a myomectomy is the only option for you ladies who are not yet ready to part with your uterus, what varies in the myomectomy part is how you “myomectomize.”

The procedure can be performed abdominally (through a bikini-cut incision), laparoscopically (through a camera), robotically (through a robot), or vaginally (no explanation needed!). The approach depends on the size of the fibroid(s), the location of the fibroid(s), and the number of fibroid (s). It also depends on your surgeon’s experience and preference. Make sure you are comfortable with all of the above before you commit to anything or anyone.

As with most things, there are pros and cons to both medical and surgical options. If you like lists (we love them!), here are the important points to note. For most young women who have not had kids but want them in the future, we like to go medical first. Most of the medical options are transient and provide birth control (killing two birds with one stone!). While they will not rid you of your “f”riends, they will decrease many of your symptoms:

Bleeding, check.

Pain, check.

Protecting your future fertility, check.

In many cases, with medical treatment, the fibroids will shrink. Fibroids feed off estrogen, so low estrogen equals famine for fibroids, and hopefully your symptoms will dissipate. If medical management doesn’t do much to alleviate your symptoms, you may have to amp up your treatment to surgery.

Surgery will almost definitely bring the bothersome bleeding, pain, and pressure to a halt. However, it can increase your chance for scar tissue (both within the uterus and the pelvis) and other surgical complications. Surgery, no matter who does it, is the real deal. For this reason, you want to avoid going under the knife unless it is absolutely necessary.

The only absolute cures for fibroids are menopause and/or a hysterectomy. For women who have baby making on their mind and in their future (be it near or distant), neither of the above is a good option: major con! It is for this reason that we need to find a way to temporize the symptoms until you get the pregnancy process started. We usually recommend starting low and going high, but only if you have to. Give the easy or simpler stuff a shot first before you shoot in out of the park.

Just a side note: while fibroids are pretty pesky for most of us, some women are completely unaware of their presence. They find out totally by accident during an ultrasound, a pelvic exam, or during pregnancy. And just like if it isn’t broken don’t fix it, fibroids that are causing no symptoms are really no big deal. They can hang with you for as long as you both shall live. No divorce in sight.

If they don’t bother you, don’t do anything with them until you have to. Prophylactic or preventative therapy to avoid future problems is not recommended—no pre-nup here! Fibroids need to be fixed only if you can’t take them anymore. Otherwise, do your best to forget they even exist!

Should They Stay, or Should They Go? The “Ovary Debate”

The ovaries are many women’s unsung heroes. They not only make the estrogen that keeps your body and brain going, but they also house the eggs that form your baby’s “better half.” Month after month and year after year, they do their job without even a pat on the back or a nod of appreciation. Unless a problem arises (a cyst forms, they stop releasing an egg, or they prematurely run out of their supply), no one pays them much mind.

Therefore, when a woman is having her uterus removed (medically termed a hysterectomy) and the question “Do you want to take or keep your ovaries?” is posed, many of us are not sure what to do. Unlike the “milk and sugar?” question, this isn’t something you’re asked on a daily basis. If you do find yourself straddling the in or out line, here are some pointers to help you make the “ovary in” or “ovary out” decision when you are planning to undergo a hysterectomy.

Think of the ovaries as a professional athlete. They peak in their 20s. After that, things start to go downhill. However, most don’t really hit retirement age until their late 40s. The ovaries hang on for even a bit longer and are producing estrogen and eggs until menopause. After this, things start to change. The estrogen production drops significantly (#helloHOTflashes), and ovulation ends.

The ovaries enter retirement; they are ready to sit back with a good book and watch the sunset. They seemingly aren’t doing a whole lot. But what their presence perpetuates is the possibility of ovarian cancer. If they stay in, there you are, at risk. And while the risk of ovarian cancer in the general population is about 1 in 70, most ovarian cancers are pretty good at hide and seek. They are often not detected until they have reached an advanced stage. This makes them a formidable foe and nobody we women want to mess with.

While the ovaries occasionally play the bad guy role, most of the time they are doing a lot of good, particularly for women who are peri-menopausal. Therefore, taking them out (medically termed an oophorectomy) may cause problems before natural menopause occurs. Issues like heart disease, osteoporosis, and cognitive impairment occur more frequently in women who experience premature surgical menopause (a.k.a. the ovaries come out before they have stopped functioning).

Even after the ovaries have taken their last bow (no more eggs and no more estrogen), they continue to produce hormones (specifically, testosterone) that are important to the postmenopausal body. Therefore, while we used to lump an oophorectomy in with a hysterectomy (sort of like peanut butter and jelly), that’s no longer the case. While removing the ovaries can eliminate your risk of ovarian cancer, it can also add to your risk of other diseases.

Bottom line, before you sign on the dotted line, you should know what you’re taking out—and why. We love widely televised debates as much as the next gal, but the ovarian preservation conversation should be between you and your GYN surgeon. He or she knows your medical history, your family history, and your risk factors for developing cancer better than anyone else. Together, you can create a pretty comprehensive pros and cons list for keeping or taking the ovaries out. Make sure to hash this one out with your doctor before you take anything out. While your vote is important, this is one decision that shouldn’t be made alone.

The Seesaw of Hormonal Production: Why Your Periods Are Wilder Than the Old- School Wild, Wild West!

When the arrival of your period becomes more erratic than airplanes during the holiday travel season, you know something is up, especially if before they were like clockwork. Why this is happening and what this all means can be confusing. It can also make deciding if you should wear white jeans very difficult! Most fingers point towards the ovaries and their dwindling supply of eggs and specific hormones: think inhibin, estrogen, and AMH.

As the ovaries start to run on empty, they shoot mixed messages to the brain. The brain, which is used to orderly and steady hormone levels from the ovaries, is thrown into a tailspin. Without adequate ovarian hormone production, the brain overproduces certain hormones. Think FSH and LH. There goes the regularity of your menses. In medicine, we refer to this period of confusion and “crazy” period timing as perimenopause. And to put it bluntly, this period (no pun intended) can be a big pain.

In terms of the brain-ovary relationship, think of a seesaw. As the ovaries (egg production and select hormones) go down, the brain’s hormone production goes up—and in some cases, way up. FSH levels can reach the high double digits. Ovarian hormones and hormones in the brain, specifically the pituitary gland, work in a negative feedback loop—high ovarian hormones keep the brain’s reproductive hormones low. So when you are nearing menopause and the ovarian production lays low, lower, and then lowest, the seesaw will remain lopsided. And while on this seesaw, the person left high won’t get hurt, it will have a major impact on how frequently you see your periods—as well as other things like your internal temperature gauge.

For most of our reproductive lives, the ovaries and the brain work as a team to prepare an egg, ovulate an egg, and maintain the corpus luteum (a.k.a. the structure that makes progesterone and helps maintain a pregnancy). There are some conditions where this system doesn’t run so smoothly—cue PCOS, thyroid disease, or hypothalamic amenorrhea. But for most of us, it is pretty well-oiled machine, that is, until we hit our mid-40s or so. Then the pendulum starts to swing erratically. Periods come closer together (about 20 days) and then farther apart and then close together AND farther apart. Not a pleasant combo.

Consistency becomes a thing of the past. While your mind may view pregnancy as a thing of the past, your ovaries haven’t quite given up. They are still working to prepare and ovulate an egg each month. Because of the diminished supply, they start to prepare the egg in the second half of the menstrual cycle the month BEFORE that egg will be ovulated. Simply stated, they are letting the horse out of the gate (a.k.a. the egg) long before the race goes off (a.k.a. the next menstrual cycle starts). As a result, the menstrual cycles will get shorter and shorter.

Although irregular menstrual cycles are quite common when we hit our 40s and beyond, when bleeding becomes excessive or all of the time, you need to speak to your OB/GYN. While it likely means nothing more than the ovarian reserve fuel tank is running on empty, you want to make sure there is nothing structural (a polyp, a fibroid, or even a cancer) that needs to come out. Don’t brush it off as another joy of aging!

Just like any relationship, when one member of the team goes haywire, things can fall apart pretty quickly. If you are not in sync with your partner, the partnership falls apart. The brain and ovary alliance is no different. When one stops working, the other one tries to overwork or make up for the deficiencies, which leads to irregular and often frequent periods. Although there may be nothing you can do to mend or tame this wild relationship (once ovarian production goes down, it generally will remain down), just acknowledging it can bring you some peace.

And with that, you can go out and face the wild, wild west!

Lighting up Will Make You Lose Your Eggs!

There are not many things in this world you can be sure of. In the words of Ben Franklin (shout out to all our fellow Penn alums), “In this world, nothing can be said to be certain except death and taxes.” And while we love you, Mr. American, we would like to add a third: cigarettes are bad for you! Despite the Marlboro Man’s best efforts, we all know nothing good can come out of lighting up. The litany of negatives when it comes to tobacco is so long, it couldn’t even fit on one page! Brain, lungs, heart, blood vessels, esophagus, stomach, hands, and feet are all victimized by the tar and tobacco filling that little white stick. While this may have been obvious to you, you may not have known how bad smoking is for your reproductive system.

Simply stated, smoking sucks for your reproductive system. Years of data have shown that smoking can lead to infertility and early menopause. In fact, women who smoke will go through menopause one to four years earlier than nonsmoking women. (Who wants hot flashes, headaches, and vaginal dryness before you need them?) And it seems that, the more you smoke, the more damage you do; with every puff you take, you are not only burning out your lungs but also your egg supply. Additionally, women who smoke are more likely to miscarry once pregnant. The chemicals in cigarettes can damage the DNA (genetic information) inside your egg and lead to a miscarriage. But it’s not only eggs that fizzle in the face of cigarettes; the fallopian tubes also sustain damage. Think of the tubes as tunnels. Their job (most of us have two!) is to transport the sperm to the egg and the fertilized embryo to the uterus. If blocked or damaged, the sperm or egg either never get together, or if they do, the embryo is more likely to get stuck on its way to the uterus. That’s called an ectopic pregnancy (pregnancy located outside of the uterus). Ectopics can be life threatening if not treated appropriately. How and why does this happen? Well, there are little hairs called cilia (we have them in our nose as well) that line the inside of our tubes. Imagine a car wash; think of the wipers that come beating down on the car when the wash first starts. That’s sort of like what the cilia look like, but rather than beating the dirt off your car, they are propelling the sperm to the egg and the embryo to the uterus. If they don’t work, you have a problem.

But get this. Even if you don’t smoke but your partner does, you are also in trouble. There are significant effects on a woman’s fertility from passive smoking (a.k.a. second-hand smoke). The effects of smoking on male infertility are less clear. Sperm function tests are poorer in smokers. There is not clear, conclusive evidence that men who smoke are more likely to be infertile, but given the impact it has on your female partner, guys, we urge you to put it out!

So let’s say you can’t quit and you find yourself pregnant and smoking. Then what? What impact is your habit having on your unborn child? If you have ever taken biology, you probably guessed it: not a very positive one! Babies born to women who smoked are at risk for growth restriction (stunted growth) inside the uterus, small birth weight, early/preterm delivery, stillbirth, and problems with the placenta.

But we get it. Despite all that, going cold turkey can be hard. Habits, no matter how bad, are hard to break. And because of all the “yuck” that is inhaled, it is actually not only okay but preferable to start nicotine replacement therapies (the patch, the gum, etc.) during pregnancy and when trying to conceive rather than continuing to smoke. Yes, they have their effects and are no prenatal vitamins, but they are way better than the tar and tobacco that you are inhaling. There are no ifs, ands, or buts about it, butts are bad for your lungs, bad for your heart, bad for your brain, bad for your skin, bad for your ovaries, and unbelievably bad for your unborn baby. You will burn through your wallet, your lungs, and your eggs. So take it from us. Put out that cigarette, and never pick one up again!

Can I Break up with My Birth Control?

The 40s are often deemed the decade of freedom. Careers are stable, and relationships are solid (for the most part). You are done with babies or opted to not go this route (and for those still on the baby journey keep this advice for later!). You are a seasoned player on almost all fronts. But just because your brain thinks pregnancy is a thing of the past doesn’t mean that your ovaries are in agreement. Despite a decrease in egg quality and quantity, you can get pregnant in your 40s, so much to your chagrin, you can’t throw your birth control out when you hit 43, 45, or even 48. As long as you are still ovulating, you can get pregnant, no matter how old you are!

The reality is that, although your body is changing, your birth control options are not much different as you move throughout the decades. No matter what age you are, the name of the game for hormonal contraception is preventing ovulation, fertilization, and implantation. While certain options might work better at certain points in your life, they will all work in preventing pregnancy. For example, we are big fans of the hormonal IUDs (Mirena, Skyla, Liletta) for women in their 40s. They not only prevent pregnancies but also do so with little systemic exposure to hormones (a.k.a. the hormones stay in the uterus rather than in other areas of the body). This reduces the risk of negative side effects from hormones. It also reduces the risk of select cancers such as uterine cancer, a malignancy that affects women as they age.

On the flip side, while oral contraceptives may have been your go to in your 20s, they may not be right for you in your 40s. Women above the age of 35 are more likely to suffer the negative side effects from oral contraceptive pills. This is because age plus issues like high blood pressure, obesity, diabetes, and high cholesterol/triglyceride levels (disease processes that are more likely to be present as we age) equal a greater chance of bad things (stroke, blood clot, etc.) happening while on oral contraceptive pills. So while oral contraceptive pills are not totally out, a good history and physical exam are required before starting them.

The bottom line is that you can’t just assume that your baby-making days have passed you by, even if you used fertility treatments to conceive or if everyone around you is using fertility treatments to get pregnant. While age is a risk factor for infertility, not every woman in her 40s is infertile. Until your periods bid you adieu, you can’t break up with your birth control. This is one relationship you can’t seem to get rid of! While your ovaries may be running on empty, they still have some gas left in the tank. And although we all love surprises, this surprise may be one that will make you do a whole lot more than scream!

Post-Menopausal Bleeding: A Drop in the Bucket?

Month after month, year after year, we are running for the bathroom searching for the tampon or pad that we keep buried in our purse for an emergency. After realizing that we used the emergency supply last month and never restocked, we seek out help from one of our bathroom mates who smiles and says, “Don’t worry; I’ve been there.” The truth is, we all have at some point; the monthly mess is just a part of a woman’s life. It can be so unpleasant—the cramps, the moods, the pimples, and of course, the endless bleeding—that it’s hard to imagine ever missing this. I mean, if your 20-year-old self could talk to your 50-year-old self, what a conversation that would be! When you are in the thick of those reproductive years, a little irregular bleeding here or there often goes unnoticed: what’s a little more bleeding? You probably don’t make much of it and maybe even forget to mention it to your doctor. It is, so to speak, just a drop in that much larger bucket. However, when bleeding arises post-menopause, it can be serious and should never be shrugged off, ignored, or go unnoticed.

Menopause is the end of a very, very, very long race; “miles” of menses ultimately come to an end. While this race is long, its end is gradual and is preceded by a major “spacing” out of rest stops. All regularity and predictability are lost, and irregularity and the unknown take the lead. Medically, this time of irregular periods is known as perimenopause; perimenopause and the haphazardness that it brings (both physical and often emotionally) can (oh joy) last for years.

It isn’t until a full year from the last period that you receive your official medal (a.k.a. menopause). From this point on, the flood gates are closed. No more bleeding should occur. Without the ebbs and flows of estrogen and progesterone made by the ovaries, the stimulus for a uterine lining to be produced and shed monthly is lost. The uterine lining becomes thin (no diet required!) and in most instances remains that way indefinitely. If it starts to receive mixed messages (um, no way, that’s not what she told me!), it can thicken and bleed. But let’s cut the game of telephone ASAP. This is not evidence that you are once again fertile. It can hint at a seriously serious situation, such as endometrial cancer, which requires immediate attention. Endometrial cancer is the most commonly diagnosed gynecologic cancer; about 55,000 women will be diagnosed in the US each year. Luckily, most endometrial cancers give you a heads up: a “get out of the way; the bus is about to hit you”-type of thing. For most women, bleeding, long after the days when there was bleeding, will happen.

Bleeding is an obvious and often early sign that something is off. Because it is so visible, endometrial (uterine) abnormalities are often picked up early in the game. In fact, in many cases, they are not even fully cancerous but rather precancerous (about 70% of endometrial cancers are stage I when diagnosed). The precancerous condition is called endometrial hyperplasia. Basically, the cells are becoming a little hyperactive and if untreated could be on their way to some serious Ritalin-requiring behavior. There are four types of endometrial hyperplasia, with some being more in line with cancer and others just slightly out of line with normal. As a common precursor to endometrial cancer, endometrial hyperplasia in a post-menopausal woman often leads to a hysterectomy.

Not all postmenopausal bleeding is bad. Some is just a reflection of a thin uterine lining or thin vaginal wall (medically termed atrophic). Think of dry hands or lips in the winter…they get dry, chapped, and cracked. This can lead to bleeding. There is no medical problem that caused the bleeding (it’s your lack of lotion and chapstick!). And while it can be unsightly, it usually doesn’t require medical treatment. The same goes for what we call endometrial atrophy. With years of low estrogen, things can sort of thin and shrivel. One such thing is your uterine lining. It can become so thin that it bleeds. Last, in certain cases the answer is C: neither of the above. Often, a benign structure like an endometrial polyp (an overgrowth of glandular tissue) can cause postmenopausal bleeding.

Our job is to sort out which type of bleeding you are having—the “I need some chapstick bleeding” or the “I need some surgery bleeding.” We don’t have eyes in the back of our head (even though our kids think we do), and we can’t diagnose endometrial pathology just by looking at your abdomen. In order to make a diagnosis, be it a cancer, hyperplasia, a polyp, or just a really thin lining, we need to perform an ultrasound and possibly even an in-office biopsy.

Sometimes, if more information is needed to make the appropriate diagnosis a D&C is required. The thickness of the uterine lining on ultrasound serves as sort of the gatekeeper for what should be done next. In this case, the line in the sand is 4mm. When the lining is less than or equal to 4mm, you pretty much have the all clear. No further testing is required unless the bleeding continues to occur because the risk of uterine cancer is so low. When the uterine lining is greater than 4mm, you have entered the no-fly zone, and further evaluation is required.

Luckily, the warning signs are fairly bright, so most endometrial cancers are diagnosed and treated early (making survival rates quite high). While most women with endometrial hyperplasia and cancer will require a surgical procedure (hysterectomy), it is a small price to pay to be cancer free. While seeing red again can be alarming, it is not always bad. However, you do need to sound the sirens (a.k.a. call your OB/GYN) and police the situation. Even the smallest drops in the bucket matter. When you are postmenopausal, every spot matters.

Step on a Crack and Break Your Mother’s Back?

While most of us can vividly remember playing this game as kids, aimlessly wandering up and down the sidewalk, we never really had any idea what this saying meant. It served as the impetus to jump over every crack, to yell at our friend whenever she landed on one, and to drive our mother crazy as it took us double the amount of time to walk down the street. Unfortunately, as we age, breaking our backs (medically speaking, our vertebrae), our hips, and our wrists becomes a reality. Osteoporosis, a bone disorder characterized by loss of bone mass, a decrease in bone quality, and a breaking down of the bone structure, affects 54 million people in this country; one in two women over the age of 50 will break a bone from osteoporosis. While you would want to play the lottery with those odds, you wouldn’t want to gamble with your life. And osteoporosis is a lot more than a cosmetic problem (broken bones, deformed spine, and hip braces). This disease not only has a significant impact on a woman’s quality of life but also her quantity of life. Approximately 3–6% of women will die in the first few weeks after being admitted to the hospital for a hip fracture and about 20% within the first year of after the fracture. Simply stated, fractures are no joke, and we should do all that we can to avoid them.

So osteoporosis is thin bones…Who gets thin bones and why? Are thin bones just a natural part of aging like grey hair and wrinkles? The answer is somewhat grey (no pun intended). While age is the most important determinant of bone quality, not all postmenopausal women will have osteoporosis. Genetics, race, and ethnicity are also key players. Caucasian women have the highest rates of osteoporosis, and African American women, the lowest. Other important risk factors include smoking, prolonged periods of no period (no period = no estrogen, no estrogen = no “water” for the bones), weight, excessive alcohol consumption, inactivity (a.k.a. couch potatoes!), poor nutrition, family history, and certain medications or medical conditions.

Another important piece to the bone jigsaw puzzle has been locked in for years and years. While it may be hard to believe, most of what will happen to our bones as adults is determined by how we lived as adolescents. During our late teens and 20s, we achieve what is called our peak bone mass. Our peak bone mass is mostly influenced by things like genetics and ethnicity (inherited factors). But even if the cards had you slotted for some good bone numbers, lifestyle, health, and environmental factors during your formation and oh-so-fun years can hinder what you can achieve (in the words of your parents…you aren’t living up to your potential!). This is why it is so important for young women to get that milk mustache, a good steady dose of estrogen, a good amount of exercise, and a good daily complement of vitamins.Even if you failed to live up to your bones’ expectations, any time you make a change is helpful: basically, better late than never.

Diagnosing osteoporosis is fairly simple, painless, and pretty quick. If done in women with some serious risk factors or at a specific age, it can be picked up years before really bad stuff and bad breaks happen. A DEXA (dual-energy X-ray absorptiometry) makes the call. A DEXA takes a picture of the lumbar spine and the hip and provides the necessary information to make the diagnosis of osteoporosis. Additional pictures are often taken of heel and wrist; these images are not as useful for making a diagnosis or for monitoring treatment (if you need it) but can provide helpful information about the extent of the underlying process. Through the DEXA, something called a bone mineral density score for each site is calculated. The numbers at each site are then compared to a young and healthy female to produce another number (ugh, math, math, and more math!). Once you get to the end of this very long equation, you can answer the question: do I have osteoporosis?

When your T score is ≤ -2.5 at ANY of the sites, you have got yourself a diagnosis.

If the T score is ≥ -1, you are in the clear.

For those between -1 and -2.5, you have what is called osteopenia.

Osteopenia is sort of like a yellow light. Your bones are slowing down, but they have yet to stop. This information can be incredibly powerful because lifestyle and medical changes can keep the road ahead clear. DEXA screening should begin no later than 65. However, for some women with any of the previously mentioned risk factors, screening should be initiated even earlier.Bottom line, this issue is fragile and needs to be handled with care! If your doctor doesn’t bring it up, you should!

We all knew milk was good for us, but who knew it was this good? Get that milk mustache ready, because a few glasses a day can help keep the cast away. Good lifestyle decisions such as calcium and vitamin D, exercise/activity, and healthy eating habits can all make a big difference. Currently the recommended daily dose for ALL women is:

1,000–1,300mg/day of calcium and 600–800 IU of vitamin D/day (specific dosing based on age). Postmenopausal woman (51–70) need 1,200 mg/day of calcium and 600 Vitamin D/day. Bottom line, milk really does do a body (and bones) good!

Lifestyle modifications and changes in your surrounding environment can also have a major impact on both on your getting osteoporosis and preventing fractures. Weight-bearing exercises (e.g., walking) and muscle-strengthening exercises can not only make you look good and feel good but also bulk up your bones (i.e., prevent osteoporosis and decrease the risk of fractures). And while we don’t want you to start moving your furniture around, it might not be a bad idea to call some friends over to help you. Modifying your living environment and adopting ways to prevent falls can reduce your risk of falls and subsequent fractures. Some other suggestions include installing better lighting (including nightlights), removing throw rugs and junk from the floor, moving cords/cables, storing items at your height (throw away the stepstool!), putting nonskid strips in the shower, and installing handrails on the steps. While we are not in the business of redecorating and love what you have done with the place, these changes can be very beneficial for your bone health.

Unfortunately, sometimes even our best efforts can’t stave off a disease. You can drink gallons of milk and eat cartons of yogurt and still get osteoporosis. But don’t get all sour; there are excellent medical treatments that can help rebuild your bone and stop future bone destruction. While many options exist, your doctor will tailor the appropriate medical treatments to your lifestyle, the extent of your disease, and your personal needs. Bisphosphonates (Fosamax) are often the first line (inhibit the cells that break down bone); while they have gotten some negative press lately, when taken under the guidance of an experienced physician, they are safe and often quite successful at keeping the damage at bay.

Just in case you were wondering where that saying, “step on a crack and break your mothers back” actually comes from (no, it has nothing to do with osteoporosis!), it is rooted in some serious old-school superstitions. It seems to have originated in the late 19th century when racism was rampant. The original verse was “step on a crack, and your mother’s baby will be black.” Pretty terrible stuff. Somehow, from that we got to the mid-20th century where the saying took some “alternative” paths. Some said that the number of cracks equaled the number of china dishes you would break, while others told children that the number of cracks equaled the number of bears around the corner waiting to eat them for lunch (that’s one way to parent!). While all beyond ridiculous, for some reason the saying has stuck. If for nothing else, use it to remember to be mindful of where you walk and to watch out for bumps in the road. Try to avoid cracks. Let’s face it; you don’t want to trip. Then you may really break some bones!